Centers for Disease 

Control and Prevention 

National Center for Injury 

Prevention and Control 

DATA 

SURVEILLANCE 

REPORT 

Surveillance Report of Traumatic Brain Injury-related Emergency 

Department Visits, Hospitalizations, and Deaths 

UNITED STATES, 2014 

LEARN MORE 

TBI: www.cdc.gov/TraumaticBrainInjury 

HEADS UP: www.cdc.gov/HEADSUP 
TBI: SURVEILLANCE REPORT DATA

 

1 

ACKNOWLEDGEMENTS
 

This Surveillance Report was prepared by staff from the National Center for Injury Prevention and Control 

(NCIPC), Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, 

Atlanta, Georgia. 

Contributors to this report included: Alexis B. Peterson, PhD1

, Likang Xu, MD, MS2, Jill Daugherty, PhD1, 

Matthew J. Breiding, PhD1

1Division of Unintentional Injury Prevention, NCIPC, CDC 

2Division of Analysis, Research, and Practice Integration, NCIPC, CDC. 

Corresponding author: Alexis B. Peterson, Apeterson4@cdc.gov 

This report focuses on traumatic brain injury (TBI) data collected from multiple sources. Data on TBI-related 

emergency department visits and hospitalizations were obtained from the 2014 Healthcare Cost and Utilization 

Project’s Nationwide Emergency Department Sample and 2014 National Inpatient Sample, sponsored by the 

Agency for Healthcare Research and Quality. Data on TBI mortality were obtained from the National Vital 

Statistics System’s 2014 multiple-cause-of-death files. 

All material in this report may be used and copied without permission, and with citation. 

Suggested citation: Centers for Disease Control and Prevention (2019). Surveillance Report of Traumatic Brain 

Injury-related Emergency Department Visits, Hospitalizations, and Deaths—United States, 2014. Centers for 

Disease Control and Prevention, U.S. Department of Health and Human Services. 

Disclaimer 

The findings and conclusions in this report are those of the authors and do not necessarily represent the views 

of the Centers for Disease Control and Prevention. 
TBI: SURVEILLANCE REPORT DATA

 

2 

EXECUTIVE SUMMARY
 

In the United States (U.S.), traumatic brain injury (TBI) is a serious public health concern that results in death 

and disability for thousands of people each year. During 2013, TBIs were diagnosed in nearly 2.8 million of the 26 

million injury-related emergency department visits, hospitalizations, and deaths that occurred in the U.S.1

This report describes 2014 national incidence estimates of TBI-related emergency department visits, 

hospitalizations, and deaths (TBI-EDHDs) by principal mechanism of injury, injury intent, and age as well as 

describes the trends in TBI incidence by principal mechanism from 2006-2014.* TBI morbidity estimates were 

derived from the Healthcare Cost and Utilization Project’s (HCUP) Nationwide Emergency Department Sample 

(NEDS) and National Inpatient Sample (NIS).^ HCUP is a suite of state-based administrative health care record 

databases that serves as a resource of encounter-level health care.2 TBI mortality estimates were derived from 

the National Vital Statistics System^

 (NVSS) which captures data for all deaths registered in all 50 U.S. states 

and the District of Columbia.3

 The 2014 data year was examined because 2014 was the final full-year in which ED 

visits, hospitalizations, and deaths were collected prior to the International Classification of Diseases diagnosis 

coding change that affected ED visits and hospitalizations. 

Key Findings: 

TBI-related Emergency Department Visits, Hospitalizations, and Deaths 

•	 In 2014, there were approximately 2.87 million TBI-EDHDs in the U.S., including over 837,000 of these health events 

among children. 

•	 The number of TBI-EDHDs in 2014 represents a 53% increase from 2006, in which there were approximately 1.88
 

million TBI-EDHDs.
 

TBI-related Emergency Department (ED) Visits 

•	 In 2014, there were approximately 2.5 million TBI-related ED visits in the U.S., including over 812,000 among children. 

•	 Unintentional falls, being unintentionally struck by or against an object, and motor vehicle crashes were the most 

common mechanisms of injury contributing to a TBI diagnosis in the ED. These three principal mechanisms of injury 

accounted for 47.9%, 17.1%, and 13.2%, respectively, of all TBI-related ED visits. 

•	 Rates of TBI-related ED visits per 100,000 population were highest among older adults aged ≥ 75 years (1,682.0), 

young children aged 0-4 years (1,618.6), and individuals aged 15-24 years (1,010.1). 

TBI-related Hospitalizations 

•	 In 2014, there were approximately 288,000 TBI-related hospitalizations in the U.S., including over 23,000 among children. 

•	 Unintentional falls and motor vehicle crashes were the most common mechanisms of injury contributing to a TBI 

diagnosis in which the patient was hospitalized. These two principal mechanisms of injury accounted for 52.3% and 

20.4%, respectively, of all TBI-related hospitalizations. 

•	 Rates of TBI-related hospitalizations per 100,000 population were highest among older adults aged ≥75 years
 

(470.6), those aged 65-74 years (145.5), and individuals aged 55-64 years (89.5).
 

TBI-related Deaths 

•	 In 2014, there were 56,800 TBI-related deaths in the U.S., including 2,529 deaths among children. 

•	 Intentional self-harm, unintentional falls, and motor vehicle crashes were the most common mechanisms of injury 

contributing to a TBI-related death. These three principal mechanisms of injury accounted for 32.5%, 28.1%, and 

18.7%, respectively, of all TBI-related deaths. 

•	 Rates of TBI-related deaths per 100,000 population were highest among older adults aged ≥75 years (78.5), those 

aged 65-74 years (24.7), and individuals aged 55-64 years (19.1). 
TBI: SURVEILLANCE REPORT DATA 3 

Trends in TBI incidence by principal mechanism, 2006-2014 

•	 Age-adjusted rates of TBI-related ED visits increased 54% from 521.6 per 100,000 population in 2006 to 801.9 in 

2014. An increase in age-adjusted rates occurred among nearly all of the major unintentional and intentional principal mechanism categories, including: 

•	 a 24% increase for TBI-related ED visits as a result of motor vehicle crashes (from 85.3 to 106); 

•	 an 80% increase for TBI-related ED visits as a result of falls (from 208.8 to 374.9); 

•	 a 58% increase for TBI-related ED visits as a result of being struck by or against an object (from 90.8 to 143.9); 

•	 a 60% increase for TBI-related ED visits ED visits as a result of intentional self-harm (from 0.5 to 0.8); and 

•	 an 18% increase for TBIs as a result of assault (from 57.6 to 67.8). 

•	 While the number of TBI-related hospitalizations increased from 2006 to 2014, age-adjusted rates of TBI-related 

hospitalizations decreased by nearly 8% during that same period (from 92.2 to 84.9 per 100,000). This decrease 

coincides with a 34% decrease in the age-adjusted rate of TBI-related hospitalizations attributable to motor vehicle 

crashes (27.6 in 2006 to 18.1 in 2014). 

•	 While the number of TBI-related deaths increased from 2006 to 2014, age-adjusted rates decreased by 6% during 

that time period (from 17.9 in 2006 to 16.8 per 100,000 in 2014). This decrease coincides with a large decrease in 

the age-adjusted rate of TBI-related deaths attributable to motor vehicle crashes (5.4 in 2006 to 3.3 in 2014). 

Limitations 

•	 Findings do not include individuals who did not seek care for their TBI or patients who sought care outside of a hospital setting (e.g., primary care, urgent care, specialty care). 

•	 Although some codes included in the TBI surveillance definition are indicative of a more severe injury, the analysis 

presented in this report did not differentiate by severity of injury. 

•	 While TBI estimates can be disaggregated into broad categories of mechanism of injury, these breakdowns do not 

allow for a more specific accounting of the causes of TBI-related injuries and limit the specificity of conclusions that 

can be drawn regarding primary causes of TBI-EDHDs. 

•	 For a sizable portion of cases there is insufficient information in the record to support assignment of a contributing 

mechanism of injury or injury intent. As a result, estimates of TBI-EDHDs by mechanism of injury and injury intent 

are underestimates. 

•	 Trends of TBI-EDHDs are reported for the most recent years in which all data are available (ED visits, hospitalizations, and deaths) prior to the International Classification of Diseases diagnosis coding change. Trends of TBI-EDHDs occurring prior to 2006 are described online.¶

Conclusions 

•	 Decreases in TBI-related hospitalizations and deaths as a result of motor vehicle crashes indicate significant progress in motor vehicle safety. 

•	 Falls were the leading cause of injury for TBI-EDHDs in 2014, and over half of TBIs attributed to falls were in the 

youngest (0-4 years) and oldest (≥75 years) age groups, suggesting a need to intensify efforts related to fall prevention, particularly in these age groups. 

•	 During the period of 2006-2014, rates of TBI-related deaths due to intentional self-harm increased 17%. This 

mirrors the increase in suicide rates overall in the U.S.,4 suggesting the need for expansion of comprehensive and 

coordinated suicide prevention efforts.#

* Note: TBI morbidity and mortality identification and classification are described in the “Methods” section 

^ Note: Data sources analyzed for TBI morbidity and mortality and data exclusions described in the “Methodological Appendix” 

¶ https://www.cdc.gov/traumaticbraininjury/data/index.html 

# https://www.cdc.gov/violenceprevention/pdf/suicideTechnicalPackage.pdf 
TBI: SURVEILLANCE REPORT DATA 4 

METHODS
 

For TBI-related ED visits and hospitalizations, cases were identified using codes from the International 

Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) based on an established surveillance 

definition for TBI morbidity.5

 Cases were included and classified as TBI-related if any of the following ICD-9­

CM diagnosis codes, regardless of position (i.e. both primary and secondary diagnoses), were included in the 

health record. These codes included: 

•	 800: fracture of vault of skull; 

•	 801: fracture of the base of skull; 

•	 803: other and unqualified skull fractures; 

•	 804: multiple fractures involving skull or face with other bones; 

•	 850: concussion; 

•	 851: cerebral laceration and contusion; 

•	 852: subarachnoid, subdural, and extradural hemorrhage, following injury; 

•	 853: other and unspecified intracranial hemorrhage following injury; 

•	 854.0, 854.1: intracranial injury of other and unspecified nature; 

•	 950.1–950.3: injury to the optic nerve and pathways; 

•	 959.01: unspecified head injury; and 

•	 995.55: shaken infant syndrome. 

HCUP’s NEDS and NIS data were weighted to provide national level estimates of annual numbers and 

rates per 100,000 population. Weighting procedures used during statistical analysis are referenced in the 

Methodological Appendix. Non-overlapping confidence intervals were used to compare annual numbers and 

rates. Each rate and its surrounding 95% confidence interval were based on U.S. bridged-race population 

estimates of the resident population.6

 U.S. census population estimates for the year 2000 were used as the 

standard for age-adjusted rates by direct method.7 If the relative standard error was >30% or the standard 

error = 0, then the value of the estimate was considered unreliable and was not reported. 

For TBI-related deaths, cases were identified using codes from the International Classification of Diseases, 

Tenth Revision, (ICD-10) based on an established surveillance definition for TBI mortality5

. Cases were included 

and classified as a TBI-related death if any of the following ICD-10 codes, regardless of position, were included 

in the NVSS mortality record. These codes included: 

•	 S01: open wound of the head; 

•	 S02.0, S02.1, S02.3, S02.7–S02.9: fracture of the skull and facial bones; 

•	 S04.0: injury to optic nerve and pathways; 

•	 S06: intracranial injury; 

•	 S07.0, S07.1, S07.8, S07.9: crushing injury of head; 

•	 S09.7–S09.9: other unspecified injuries of head; 

•	 T90.1, T90.2, T90.4, T90.5, T90.8, T90.9: sequelae of injuries of head. 

Data on TBI-EDHDs were stratified by age, principal mechanism of injury, and injury intent. Age groups 

assessed included ages 0-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, and ≥75 years. 
TBI: SURVEILLANCE REPORT DATA

 

5 

Estimates of pediatric TBI-EDHDs were calculated separately by grouping TBI-EDHDs in those ≤17 years of age. 

Principal mechanisms of injury assessed included motor vehicle crashes, falls, being struck by or against an 

object, intentional self-harm, assault/homicide, mechanism unspecified, and other/no mechanism specified. 

Injury intent was categorized as unintentional (motor vehicle crashes, falls, being struck by or against an 

object, mechanism unspecified), intentional (self-harm and assault/homicide), and undetermined intent. 

Estimates of TBI-EDHDs attributable to self-harm were suppressed for the 0-4, 5-14, and ≤17 year age groups 

as suicidal intent in children aged <10 years remains unclear.8

To assess TBI-related ED visits and hospitalizations by principal mechanism of injury and injury intent we 

utilized CDC’s recommended framework for grouping external cause of injury codes (E-codes) using ICD-9­

CM.9

 E-codes analyzed included E800-E966 and E968-E999. E-codes for an injury-related activity (E000), 

place of injury occurrence (E001-E030), or perpetrator of abuse (E967) were excluded from this analysis. 

First-listed valid E-code was used in this study, as it is assumed the first listed code is the principal mechanism 

of injury10 for the diagnosed TBI. For TBI-related deaths, principal mechanisms of injury and injury intent were 

categorized based on the CDC-recommended E-code mortality matrix for ICD-10.11 Trends for TBI-EDHDs 

encountered during 2006 to 2014 were assessed by collapsing national level estimated counts of each health 

event attributable to relevant principal mechanisms of injury and injury intents (i.e. E800-E966 and E968-E999 

codes assessed) for each data year. 
TABLES 

Traumatic Brain Injury-related Emergency Department Visits, 

Hospitalizations, and Deaths 

UNITED STATES, 2014 
TBI: SURVEILLANCE REPORT DATA 7 

 

 

 

TABLES AND FIGURES
 

Table 1: Estimated number and rate of traumatic brain injury–related emergency department visits,
 

hospitalizations, and deaths, by age group — United States, 2014
 

Table 2: Estimated number and rate of traumatic brain injury–related emergency department visits, by age
 

group and mechanism of injury — United States, 2014
 

Table 3: Estimated number and rate of traumatic brain injury–related hospitalizations, by age group and
 

mechanism of injury — United States, 2014
 

Table 4: Number and rate of traumatic brain injury-related deaths, by age group and mechanism of injury —
 

United States, 2014
 

Figure 1: Estimated number of traumatic brain injury-related emergency department visits, hospitalizations,
 

and deaths by year — United States, 2006-2014
 

Figure 2A: Estimated age-adjusted rates, per 100,000 population, of traumatic brain injury–related emergency
 

department visits, by year and mechanism of injury — United States, 2006-2014
 

Figure 2B: Estimated number of traumatic brain injury–related emergency department visits, by year and
 

mechanism of injury — United States, 2006-2014
 

Figure 3A: Estimated age-adjusted rates, per 100,000 population, of traumatic brain injury–related
 

hospitalizations, by year and mechanism of injury — United States, 2006-2014
 

Figure 3B: Estimated number of traumatic brain injury–related hospitalizations, by year and mechanism of
 

injury — United States, 2006-2014
 

Figure 4A: Age-adjusted rates, per 100,000 population, of traumatic brain injury–related deaths, by year and
 

mechanism of injury — United States, 2006-2014
 

Figure 4B: Number of traumatic brain injury–related deaths, by year and mechanism of injury — United States,
 

2006-2014
 
TBI: SURVEILLANCE REPORT DATA

 

8 

TABLE 1: ESTIMATED NUMBER AND RATE OF TRAUMATIC BRAIN INJURY–RELATED EMERGENCY DEPARTMENT VISITS, HOSPITALIZATIONS, AND DEATHS, BY AGE GROUP, 2014 

Age Group 

Emergency Department Visits Hospitalizations Deaths Total 

No. Rate (95% CI)* No. Rate (95% CI)* No. Rate (95% CI)* No. Rate (95% CI)*

0-17 812,237 1,103.9 (1,011.7-1,196.1) 23,075 31.4 (27.6-35.1) 2,529 3.4 (3.3-3.6) 837,841 1,138.7 (1,046.6-1,230.9) 

0-4 321,740 1,618.6 (1,452.6-1,784.6) 8,970 45.1 (38.5-51.7) 721 3.6 (3.4-3.9) 331,431 1,667.4 (1,501.5-1,833.2) 

5-14 340,274 826.1 (758.4-893.9) 8,245 20.0 (17.1-22.9) 774 1.9 (1.7-2.0) 349,293 848.0 (780.3-915.7) 

15-24 443,920 1,010.1 (957.6-1,062.5) 26,420 60.1 (55.3-64.9) 6,311 14.4 (14.0-14.7) 476,651 1,084.6 (1,032.0-1,137.2) 

25-34 287,452 661.4 (623.0-699.9) 25,480 58.6 (54.1-63.2) 6,371 14.7 (14.3-15.0) 319,303 734.7 (696.0-773.4) 

35-44 213,982 529.1 (498.7-559.4) 20,935 51.8 (48.1-55.4) 5,545 13.7 (13.3-14.1) 240,462 594.5 (564.0-625.1) 

45-54 227,341 523.9 (493.9-553.8) 30,740 70.8 (66.4-75.2) 7,336 16.9 (16.5-17.3) 265,417 611.6 (581.4-641.8) 

55-64 198,020 494.6 (466.7-522.6) 35,840 89.5 (84.8-94.2) 7,652 19.1 (18.7-19.5) 241,512 603.3 (575.0-631.5) 

65-74 166,135 629.7 (592.7-666.7) 38,395 145.5 (139.2-151.8) 6,526 24.7 (24.1-25.3) 211,056 800.0 (762.5-837.5) 

75+ 333,528 1,682.0 (1,566.1-1,797.9) 93,320 470.6 (452.8-488.5) 15,562 78.5 (77.2-79.7) 442,410 2,231.1 (2,114.0-2,348.3) 

Total 2,532,393 794.9 (752.6-837.3) 288,345 90.5 (86.5-94.6) 56,800 17.8 (17.7-18.0) 2,877,538 903.3 (860.8-945.7) 

Adjusted¶ 804.8 (784.6-825.0) 86.1 (84.3-88.0) 17.0 (16.9-17.2) 907.9 (887.6-928.3) 

Key Findings: 

•	 In 2014, there were approximately 2.87 million TBI-EDHDs in the United
 

States, including over 837,000 occurring among children. This includes:
 

•	 Approximately 2.53 million TBI-related ED visits, including over 812,000 

occurring among children. 

•	 Approximately 288,000 TBI-related hospitalizations, including over 

23,000 occurring among children. 

•	 56,800 TBI-related deaths, including 2,529 occurring among children 

•	 The highest rates of total TBI-EDHDs were seen among older adults aged ≥75 

years (2,231.1 per 100,000 population), children aged 0-4 years (1,667.4), 

and individuals aged 15-24 years (1,010.1). 

•	 Rates of TBI-related ED visits were highest among those aged ≥75 years
 

(1,682.0), 0-4 years (1,618.6), and 15-24 years (1,010.1).
 

SOURCES 

•	 Individuals aged 15-24 had the highest number of TBI-related ED visits in 2014, 

accounting for 17.5% (N=443,920) of all TBI-related ED visits for the year. 

•	 Rates of TBI-related hospitalizations were highest among older adults aged 

≥75 years (470.6), adults aged 65-74 years (145.5) and those aged 55-64 

years (89.5). 

•	 Those aged ≥75 years had the highest rate (78.5) of TBI-related deaths out 

of all of the age groups, followed by individuals aged 65-74 years (24.7) and 

55-64 years (19.1). 

•	 Adults aged ≥75 years accounted for the highest proportion of all TBI-related 

hospitalizations (32.4%; N=93,320) and deaths (27.4%; N=15,562) among all 

the age groups analyzed. 

For emergency department visits, Healthcare Cost and Utilization Project’s (HCUP) Nationwide Emergency Department Sample; for hospitalizations, HCUP’s Nationwide Inpatient Sample;
 

for deaths, CDC’s National Vital Statistics System. 


Abbreviations: CI = confidence interval. *

Per 100,000 population. ¶Age-adjusted to the 2000 U.S. standard population.
 
TBI: SURVEILLANCE REPORT DATA

 

9 

TABLE 2: ESTIMATED NUMBER AND RATE OF TRAUMATIC BRAIN INJURY–RELATED EMERGENCY DEPARTMENT VISITS, BY AGE GROUP AND MECHANISM OF INJURY, 2014 

Age 

Group 

Motor vehicle crashes Unintentional falls††

Unintentionally struck by or 

against an object 

Other unintentional injury, 

mechanism unspecified‡‡ Intentional self-harm Assault 

Other or no mechanism 

specified§§

No. Rate (95% CI)* No. Rate (95% CI)* No. Rate (95% CI)* No. Rate (95% CI)* No. Rate (95% CI)* No. Rate (95% CI)* No. Rate (95% CI)*

0-17 47,138 64.1 (59.5-68.6) 397,190 539.8 (487.7-592.0) 229,236 311.6 (285.1-338.0) 55,785 75.8 (69.9-81.8) ## ## 24,360 33.1 (30.5-35.7) 57,983 78.8 (51.1-106.5) 

## ## 0-4 5,464 27.5 (24.3-30.6) 230,776 1,161.0 (1,035.5-1,286.5) 53,436 268.8 (241.6-296.1) 12,007 60.4 (52.9-67.9) 674 3.4 (2.8-4.0) 19,360 97.4 (56.1-138.7) 

## ## 5-14 19,785 48.0 (43.8-52.3) 133,084 323.1 (293.9-352.4) 120,839 293.4 (267.3-319.4) 30,656 74.4 (68.7-80.1) 9,690 23.5 (21.3-25.8) 26,022 63.2 (41.6-84.7) 

15-24 103,892 236.4 (220.8-252.0) 96,568 219.7 (207.0-232.4) 106,679 242.7 (227.1-258.3) 37,118 84.5 (79.6-89.3) 870 2.0 (1.6-2.3) 65,399 148.8 (139.1-158.5) 33,395 76.0 (56.8-95.2) 

25-34 71,641 164.8 (152.9-176.8) 70,210 161.6 (151.9-171.2) 44,404 102.2 (95.6-108.8) 22,360 51.5 (47.9-55.0) 650 1.5 (1.2-1.8) 57,213 131.6 (122.3-141.0) 20,974 48.3 (35.1-61.5) 

35-44 44,108 109.1 (101.0-117.1) 68,830 170.2 (160.1-180.3) 32,479 80.3 (75.0-85.6) 17,541 43.4 (40.4-46.3) 421 1.0 (0.8-1.3) 34,100 84.3 (78.1-90.5) 16,503 40.8 (29.7-52.0) 

45-54 40,020 92.2 (85.4-99.0) 95,127 219.2 (206.5-231.9) 30,495 70.3 (65.4-75.2) 17,808 41.0 (38.2-43.8) 247 0.6 (0.4-0.7) 27,682 63.8 (58.7-68.8) 15,962 36.8 (27.1-46.5) 

55-64 27,193 67.9 (62.9-73.0) 112,460 280.9 (264.3-297.5) 20,408 51.0 (47.4-54.5) 12,928 32.3 (30.0-34.6) 105 0.3 (0.2-0.4) 11,538 28.8 (26.5-31.2) 13,387 33.4 (24.7-42.1) 

¶¶ ¶¶ 65-74 13,829 52.4 (48.4-56.5) 120,327 456.1 (428.3-483.8) 11,937 45.2 (41.7-48.8) 7,077 26.8 (24.6-29.0) 2,893 11.0 (9.7-12.2) 10,051 38.1 (27.8-48.4) 

¶¶ ¶¶ 75+ 8,176 41.2 (37.7-44.8) 286,031 1,442.5 (1,339.3-1,545.6) 13,270 66.9 (60.4-73.4) 7,440 37.5 (34.0-41.1) 1,260 6.4 (5.4-7.3) 17,318 87.3 (65.1-109.6) 

Total 334,109 104.9 (98.0-111.8) 1,213,412 380.9 (358.5-403.3) 433,947 136.2 (127.3-145.2) 164,935 51.8 (48.9-54.6) 2,567 0.8 (0.7-0.9) 210,450 66.1 (61.7-70.4) 172,974 54.3 (40.2-68.4) 

Adjusted¶ 106.1 (102.8-109.3) 378.6 (366.4-390.7) 142.8 (137.8-147.8) 53.1 (51.7-54.6) 0.8 (0.8-0.9) 68.1 (65.8-70.3) 55.3 (49.3-61.3) 

Key Findings: 

•	 The most common principal mechanisms of injury were unintentional falls or against an object were highest among those aged 5-14 years (293.4), 0-4 

(378.6 per 100,000 population, age-adjusted), being unintentionally struck years (268.8), and 15-24 years (242.7).
 

by or against an object (142.8), and motor vehicle crashes (106.1). During
 •	 Rates of TBI-related ED visits attributable to motor vehicle crashes were 

highest among those aged 15-24 years (236.4), 25-34 years (164.8), and

35-44 years (109.1). 

2014, these top three principal mechanisms of injury accounted for 47.9%, 

17.1%, and 13.2%, respectively, of all TBI-related ED visits. 

•	 TBI-related ED visits attributable to falls were most common among older •	 Among children aged 0-17 years, analyzed separately, the most common

principal mechanisms of injury for TBI-related ED visits were falls (rate

of 539.8), being struck by or against an object (311.6), and motor vehicle 

crashes (64.1). 

adults aged ≥75 years (rate of 1,442.5), young children aged 0-4 years 

(1,161.0), and individuals 65-74 years (456.1). 

•	 Rates of TBI-related ED visits attributable to being unintentionally struck by 

SOURCES 

Healthcare Cost and Utilization Project’s (HCUP) Nationwide Emergency Department Sample. 

Abbreviations: CI = confidence interval. *

Per 100,000 population. ††Includes falls of undetermined intent to maintain consistency with past data releases. ‡‡ E-codes specify that the injury 

was unintentional but do not specify the actual mechanism of injury. §§Includes TBIs in which the intent was not determined as well as those due to legal intervention or war. Includes TBIs 

in which no mechanism was specified in the record. Does not include falls of undetermined intent. ##Estimates suppressed for the 0–4, 5–14, and 0-17age groups. ¶¶The relative standard 

error was >30% or the standard error = 0. ¶

Age-adjusted to the 2000 U.S. standard population. 
TBI: SURVEILLANCE REPORT DATA 10 

TABLE 3: ESTIMATED NUMBER AND RATE OF TRAUMATIC BRAIN INJURY–RELATED HOSPITALIZATIONS, BY AGE GROUP AND MECHANISM OF INJURY, 2014 

 Age Group 

Motor vehicle crashes Unintentional falls††

Unintentionally struck 

by or against an object 

Other unintentional injury, 

mechanism unspecified‡‡ Intentional self-harm Assault 

Other or no 

mechanism specified§§

No. Rate (95% CI)* No. Rate (95% CI)* No. Rate (95% CI)* No. Rate (95% CI)* No. Rate (95% CI)* No. Rate (95% CI)* No. Rate (95% CI)*

0-17 5,830 7.9 (6.9-9.0) 7,935 10.8 (9.4-12.2) 1,985 2.7 (2.3-3.1) 3,135 4.3 (3.6-4.9) ## ## 1,535 2.1 (1.7-2.5) 2,595 3.5 (2.6-4.5) 

0-4 870 4.4 (3.4-5.4) 4,700 23.6 (20.1-27.2) 510 2.6 (2.0-3.2) 785 3.9 (3.1-4.8) ## ## 960 4.8 (3.7-5.9) 1,140 5.7 (4.1-7.4) 

5-14 2,395 5.8 (4.8-6.8) 2,270 5.5 (4.7-6.3) 980 2.4 (1.9-2.9) 1,435 3.5 (2.8-4.2) ## ## 195 0.5 (0.3-0.6) 955 2.3 (1.6-3.1) 

15-24 12,925 29.4 (26.5-32.3) 3,910 8.9 (8.0-9.8) 1,070 2.4 (2.1-2.8) 3,060 7.0 (6.2-7.7) 280 0.6 (0.5-0.8) 3,125 7.1 (6.3-7.9) 2,050 4.7 (3.7-5.7) 

25-34 11,050 25.4 (22.9-27.9) 4,470 10.3 (9.3-11.2) 635 1.5 (1.2-1.7) 2,600 6.0 (5.3-6.7) 440 1.0 (0.8-1.2) 4,320 9.9 (8.8-11.0) 1,965 4.5 (3.6-5.5) 

35-44 7,305 18.1 (16.2-19.9) 5,640 13.9 (12.8-15.0) 610 1.5 (1.2-1.8) 2,255 5.6 (4.9-6.2) 340 0.8 (0.6-1.0) 2,865 7.1 (6.3-7.9) 1,920 4.7 (3.9-5.6) 

45-54 8,490 19.6 (17.6-21.5) 12,010 27.7 (26.0-29.4) 685 1.6 (1.3-1.9) 3,140 7.2 (6.5-8.0) 350 0.8 (0.6-1.0) 3,290 7.6 (6.8-8.4) 2,775 6.4 (5.4-7.4) 

55-64 7,280 18.2 (16.5-19.9) 18,490 46.2 (43.8-48.6) 765 1.9 (1.6-2.2) 3,165 7.9 (7.1-8.7) 145 0.4 (0.2-0.5) 1,780 4.4 (3.9-5.0) 4,215 10.5 (9.2-11.8) 

65-74 4,485 17.0 (15.3-18.7) 25,235 95.6 (91.4-99.9) 790 3.0 (2.5-3.5) 2,180 8.3 (7.4-9.1) 85 0.3 (0.2-0.5) 535 2.0 (1.6-2.4) 5,085 19.3 (17.2-21.4) 

75+ 3,965 20.0 (18.0-22.0) 74,005 373.2 (358.3-388.1) 1,045 5.3 (4.5-6.0) 2,550 12.9 (11.7-14.1) 70 0.4 (0.2-0.5) 325 1.6 (1.2-2.0) 11,360 57.3 (51.4-63.2) 

Total 58,765 18.4 (16.9-20.0) 150,730 47.3 (45.5-49.1) 7,090 2.2 (2.1-2.4) 21,170 6.6 (6.2-7.1) 1,730 0.5 (0.5-0.6) 17,395 5.5 (5.0-5.9) 31,465 9.9 (8.8-11.0) 

Adjusted¶ 18.2 (17.4-18.9) 43.9 (42.9-45.0) 2.2 (2.1-2.3) 6.5 (6.2-6.7) 0.6 (0.5-0.6) 5.5 (5.3-5.8) 9.3 (8.8-9.8) 

Key Findings: 

•	 Unintentional falls accounted for the highest age-adjusted rate (43.9 per •	 Among children aged 0-17 years, analyzed separately, the most common
 

100,000 population) and proportion (52.3%; N=150,730) of all TBI-relat- principal mechanisms of injury for TBI-related hospitalizations were falls
 

ed hospitalizations. Rates for TBI-related hospitalizations attributable to (rate of 10.8) and motor vehicle crashes (7.9).


unintentional falls were most prominent among older adults aged ≥75 years
 

(373.2), 65-74 years (95.6), and 55-64 years (46.2).
 

•	 Motor vehicle crashes were the second most common mechanism of injury
 

with an age-adjusted rate of 18.2 and accounted for 20.4% (N=58,765) of
 

TBI-related hospitalizations. Age groups with the highest rate of motor vehicle crashes leading to a TBI-related hospitalization were 15-24 years (29.4),
 

25-34 years (25.4), and 45-54 years of age (19.6).
 

SOURCES 

Healthcare Cost and Utilization Project’s (HCUP) Nationwide Inpatient Sample. 

Abbreviations: CI = confidence interval. *

Per 100,000 population. ††Includes falls of undetermined intent to maintain consistency with past data releases. ‡‡ E-codes specify that the injury 

was unintentional but do not specify the actual mechanism of injury. §§Includes TBIs in which the intent was not determined as well as those due to legal intervention or war. Includes TBIs 

in which no mechanism was specified in the record. Does not include falls of undetermined intent. ##Estimates suppressed for the 0–4, 5–14, and 0-17 age groups. ¶¶The relative standard 

error was >30% or the standard error = 0. ¶

Age-adjusted to the 2000 U.S. standard population. 
TBI: SURVEILLANCE REPORT DATA

 

11 

TABLE 4: NUMBER AND RATE OF TRAUMATIC BRAIN INJURY-RELATED DEATHS, BY AGE GROUP AND MECHANISM OF INJURY — UNITED STATES, 2014 

Age Group 

Motor vehicle crashes Unintentional falls††

Unintentionally struck 

by or against an object 

Other unintentional injury, 

mechanism unspecified‡‡ Intentional self-harm Homicide 

Other or no mechanism 

specified§§

No. Rate (95% CI)* No. Rate (95% CI)* No. Rate (95% CI)* No. Rate (95% CI)* No. Rate (95% CI)* No. Rate (95% CI)* No. Rate (95% CI)*

0-17 931 1.3 (1.2-1.3) 48 0.1 (0.0-0.1) 52 0.1 (0.1-0.1) 308 0.4 (0.4-0.5) ## ## 611 0.8 (0.8-0.9) 61 0.1 (0.1-0.1) 

0-4 187 0.9 (0.8-1.1) 19 0.1 (0.1-0.1) 27 0.1 (0.1-0.2) 136 0.7 (0.6-0.8) ## ## 322 1.6 (1.4-1.8) 30 0.2 (0.1-0.2) 

5-14 326 0.8 (0.7-0.9) 16 0.0 (0.0-0.1) 19 0.0 (0.0-0.1) 110 0.3 (0.2-0.3) ## ## 117 0.3 (0.2-0.3) 19 0.0 (0.0-0.1) 

15-24 2,419 5.5 (5.3-5.7) 95 0.2 (0.2-0.3) 21 0.0 (0.0-0.1) 344 0.8 (0.7-0.9) 2,171 4.9 (4.7-5.1) 1,165 2.7 (2.5-2.8) 96 0.2 (0.2-0.3) 

25-34 1,960 4.5 (4.3-4.7) 175 0.4 (0.3-0.5) 34 0.1 (0.1-0.1) 345 0.8 (0.7-0.9) 2,622 6.0 (5.8-6.3) 1,110 2.6 (2.4-2.7) 125 0.3 (0.2-0.3) 

35-44 1,402 3.5 (3.3-3.6) 328 0.8 (0.7-0.9) 41 0.1 (0.1-0.1) 388 1.0 (0.9-1.1) 2,502 6.2 (5.9-6.4) 732 1.8 (1.7-1.9) 152 0.4 (0.3-0.4) 

45-54 1,484 3.4 (3.2-3.6) 908 2.1 (2.0-2.2) 62 0.1 (0.1-0.2) 618 1.4 (1.3-1.5) 3,334 7.7 (7.4-7.9) 633 1.5 (1.3-1.6) 297 0.7 (0.6-0.8) 

55-64 1,287 3.2 (3.0-3.4) 1,674 4.2 (4.0-4.4) 70 0.2 (0.1-0.2) 585 1.5 (1.3-1.6) 3,233 8.1 (7.8-8.4) 410 1.0 (0.9-1.1) 393 1.0 (0.9-1.1) 

65-74 797 3.0 (2.8-3.2) 2,324 8.8 (8.5-9.2) 60 0.2 (0.2-0.3) 504 1.9 (1.7-2.1) 2,244 8.5 (8.2-8.9) 241 0.9 (0.8-1.0) 356 1.3 (1.2-1.5) 

75+ 794 4.0 (3.7-4.3) 10,400 52.4 (51.4-53.5) 44 0.2 (0.2-0.3) 859 4.3 (4.0-4.6) 2,212 11.2 (10.7-11.6) 174 0.9 (0.7-1.0) 1,079 5.4 (5.1-5.8) 

Total 10,656 3.3 (3.3-3.4) 15,939 5.0 (4.9-5.1) 378 0.1 (0.1-0.1) 3,889 1.2 (1.2-1.3) 18,485 5.8 (5.7-5.9) 4,906 1.5 (1.5-1.6) 2,547 0.8 (0.8-0.8) 

Adjusted 3.3 (3.2-3.4) 4.6 (4.6-4.7) 0.1 (0.1-0.1) 1.2 (1.1-1.2) 5.5 (5.5-5.6) 1.6 (1.5-1.6) 0.7 (0.7-0.8) ¶

Key Findings: 

•	 Intentional self-harm accounted for the highest age-adjusted rate (5.5 per had the highest rate of TBI-related deaths caused by unintentional falls, with 

100,000 population, age-adjusted) and proportion (32.5%) of all TBI-related rates of 52.4, 8.8, and 4.2, respectively. 

deaths in the U.S. •	 Rates of TBI-related deaths attributable to motor vehicle crashes were high­

•	 Unintentional falls were not far behind with an age-adjusted rate of 4.6 and est among those aged 15-24 years (5.5), 25-34 years (4.5), and older adults 

accounted for 28.1% of all TBI-related deaths. aged ≥75 years (4.0). 

•	 Motor vehicle crashes were the third most common cause of TBI-related deaths •	 The top principal mechanism of injury leading to TBI-related death among 

in 2014, with an age-adjusted rate of 3.3 and contributing to 10,656 deaths.	 young children and adolescents aged 0-17 years was motor vehicle crashes 

(1.3). •	 Rates of TBI-related deaths attributable to intentional self-harm were
 

highest among those aged ≥75 years (11.2), 65-74 years (8.5), and 55-64
 

years (8.1). The same age groups (≥75 years, 65-74 years, and 55-64 years)
 

SOURCES 

CDC’s National Vital Statistics System. 

Abbreviations: CI = confidence interval. *

Per 100,000 population. ††Includes falls of undetermined intent to maintain consistency with past data releases. ‡‡E-codes specify that the injury 

was unintentional but do not specify the actual mechanism of injury. §§Includes TBIs in which the intent was not determined as well as those due to legal intervention or war. Includes TBIs 

in which no mechanism was specified in the record. Does not include falls of undetermined intent. ## Counts suppressed for the 0–4, 5–14, and 0-17 age groups.¶

Age-adjusted to the 2000 

U.S. standard population. 
FIGURES 

Trends in Traumatic Brain Injury Incidence by Principal Mechanism of 

Injury and Injury Intent 

UNITED STATES, 2006–2014 
TBI: SURVEILLANCE REPORT DATA

 

 

13 

FIGURE 1: ESTIMATED NUMBER OF TRAUMATIC BRAIN INJURY-RELATED EMERGENCY DEPARTMENT VISITS,
 

HOSPITALIZATIONS, AND DEATHS (TBI-EDHDS) BY YEAR, 2006-2014
 

2006 2007 2008 2009 2010 2011 2012 2013 2014 

EDHDs total 1,884,195 1,925,173 2,019,166 2,377,868 2,521,966 2,653,617 2,735,909 2,797,754 2,877,757 

Emergency department visits 1,551,107 1,603,124 1,698,326 2,047,886 2,143,133 2,332,299 2,390,167 2,460,278 2,532,537 

Hospitalizations 278,655 267,350 267,015 277,315 325,996 267,480 290,360 281,555 288,420 

Deaths 54,433 54,699 53,825 52,667 52,837 53,837 55,382 55,921 56,800 

Key Findings: 

•	 The number of total TBI-EDHDs increased by 53% •	 During this same time period the number of TBI-refrom 2006 (N approximately 1.88 million) to 2014 (N lated ED visits increased by 63%, the number of 

approximately 2.88 million). TBI-related hospitalizations increased by 3.5%, and 

the number of TBI-related deaths increased by 4.3%. 

SOURCE 

Healthcare Cost and Utilization Project’s (HCUP) Nationwide Emergency Department Sample for emergency department visits; HCUP’s 

Nationwide Inpatient Sample for hospitalizations; CDC’s National Vital Statistics System for deaths. 
TBI: SURVEILLANCE REPORT DATA

2006 

85.3 

208.8 

90.8 

40.4 

0.5 

57.6 

38.2 

521.6 

Motor vehicle crashes 

Unintentional falls††

Unintentionally struck by or against an object 

Other unintentional injury, mechanism unspecified‡‡

Intentional self-harm 

Assault 

Other or no mechanism specified§§

Total 

2007 

83.8 

221.7 

90.6 

42.7 

0.4 

56.8 

37.7 

533.8 

2008 

83.9 

240.9 

95.8 

43.1 

0.5 

60.3 

35.3 

559.8 

2009 

88.7 

298.8 

123.9 

49.5 

0.6 

64.6 

44.2 

670.2 

2010 

95.3 

316.3 

127.0 

50.5 

0.6 

68.7 

41.1 

699.5 

2011 

98.7 

348.7 

138.8 

53.4 

0.7 

68.9 

47.1 

756.3 

2012 

99.9 

355.9 

149.8 

55.4 

0.7 

69.9 

40.4 

771.9 

2013 

99.6 

362.9 

141.0 

54.1 

0.7 

68.0 

58.3 

784.6 

2014 

106.0 

374.9 

143.9 

53.2 

0.8 

67.8 

55.3 

801.9 

 

 

14 

FIGURE 2A: ESTIMATED AGE-ADJUSTED RATES¶

, PER 100,000 POPULATION, OF TRAUMATIC BRAIN INJURY–
 

RELATED EMERGENCY DEPARTMENT VISITS, BY YEAR AND MECHANISM OF INJURY, 2006-2014
 

Key Findings: 

•	 Age-adjusted rates of TBI-related ED visits increased 

from 521.6 per 100,000 population in 2006 to 801.9 

in 2014, representing nearly a 54% increase. 

•	 This increase in age-adjusted rates of TBI-related ED 

visits occurred among nearly all of the major unintentional and intentional principal mechanism categories: 

•	 A 24% increase for TBIs as result of motor vehicle 

crashes (from 85.3 to 106, age-adjusted), 

•	 An 80% increase due to falls (from 208.8 to 374.9), 

SOURCE 

•	 A 58% increase due to being struck by or against an 

object (from 90.8 to 143.9), 

•	 A 60% increase in intentional self-harm (from 0.5 

to 0.8), and 

•	 An 18% increase due to assault (from 57.6 to 67.8). 

Healthcare Cost and Utilization Project’s (HCUP) Nationwide Emergency Department Sample. 

¶

Age-adjusted to the 2000 U.S. standard population. ††Includes falls of undetermined intent to maintain consistency with past data releases. 

‡‡E-codes specify that the injury was unintentional but do not specify the actual mechanism of injury. §§Includes TBIs in which the intent 

was not determined as well as those due to legal intervention or war. Includes TBIs in which no mechanism was specified in the record. 

Does not include falls of undetermined intent. 
TBI: SURVEILLANCE REPORT DATA

2006 

254,793 

625,098 

266,268 

118,834 

1,401 

171,327 

113,386 

Motor vehicle crashes 

Unintentional falls††

Unintentionally struck by or against an object 

Other unintentional injury, mechanism unspecified‡‡

Intentional self-harm 

Assault 

Other or no mechanism specified§§

2007 

252,459 

672,504 

267,175 

126,635 

1,254 

169,638 

113,460 

2008 

254,391 

740,528 

284,297 

129,046 

1,425 

181,246 

107,392 

2009 

270,240 

928,049 

369,348 

148,703 

1,669 

195,231 

134,646 

2010 

292,942 

980,245 

379,601 

153,309 

1,807 

209,062 

126,166 

2011 

305,694 

1,090,575 

415,408 

162,553 

2,029 

210,772 

145,268 

2012 

311,271 

1,120,041 

447,591 

169,233 

2,214 

214,776 

125,041 

2013 

312,048 

1,163,473 

423,477 

167,107 

2,284 

210,220 

181,668 

2014 

334,144 

1,213,476 

433,951 

164,942 

2,567 

210,469 

172,988 

 

15 

FIGURE 2B: ESTIMATED NUMBER OF TRAUMATIC BRAIN INJURY–RELATED EMERGENCY DEPARTMENT 

VISITS†

, BY YEAR AND MECHANISM OF INJURY, 2006-2014 

Key Findings: 

•	 The number of TBI-related ED visits increased by 63% •	 94.1% increase for falls, 68% increase in being 

from nearly 1.6 million in 2006 to 2.5 million in 2014. struck by or against an object, 

•	 This increase in the number of TBI-related ED visits •	 83.2% increase in intentional self-harm, and 

occurred among nearly all of the major unintentional •	 52.6% increase in assault. 

and intentional principal mechanism categories,
 

including a:
 

•	 31.1% increase for TBIs as result of motor vehicle
 

crashes,
 

SOURCE 

Healthcare Cost and Utilization Project’s (HCUP) Nationwide Emergency Department Sample. 

†

Persons who were hospitalized, died, or were transferred to another facility were excluded.††Includes falls of undetermined intent to 

maintain consistency with past data releases. ‡‡E-codes specify that the injury was unintentional but do not specify the actual mechanism 

of injury. §§Includes TBIs in which the intent was not determined as well as those due to legal intervention or war. Includes TBIs in which 

no mechanism was specified in the record. Does not include falls of undetermined intent. 
TBI: SURVEILLANCE REPORT DATA

2006 

27.6 

33.9 

2.7 

7.3 

0.4 

7.1 

13.0 

92.2 

Motor vehicle crashes 

Unintentional falls††

Unintentionally struck by or against an object 

Other unintentional injury, mechanism unspecified‡‡

Intentional self-harm 

Assault 

Other or no mechanism specified§§

Total 

2007 

23.5 

33.5 

2.6 

6.5 

0.4 

6.8 

13.8 

87.2 

2008 

23.4 

38.1 

2.5 

7.2 

0.4 

7.4 

6.9 

85.8 

2009 

22.7 

40.2 

2.5 

7.0 

0.4 

7.2 

7.9 

87.9 

2010 

27.0 

44.6 

2.9 

8.0 

0.6 

8.3 

11.2 

102.5 

2011 

18.4 

40.6 

2.3 

6.3 

0.5 

6.0 

8.4 

82.5 

2012 

21.0 

42.0 

2.5 

6.7 

0.5 

6.2 

9.4 

88.4 

2013 

18.8 

41.2 

2.2 

6.2 

0.5 

5.6 

9.7 

84.2 

2014 

18.1 

42.9 

2.2 

6.4 

0.6 

5.5 

9.2 

84.9 

16 

FIGURE 3A: ESTIMATED AGE-ADJUSTED RATES¶

, PER 100,000 POPULATION, OF TRAUMATIC BRAIN INJURY–
 

RELATED HOSPITALIZATIONS, BY YEAR AND MECHANISM OF INJURY, 2006-2014
 

Key Findings: 

•	 From 2006 to 2014, age-adjusted rates of TBI-related •	 Despite the overall decrease in TBI-related hospitalhospitalizations decreased by nearly 8% (from 92.2 ization rates, there were increases in the age-adjusted 

per 100,000 population to 84.9). rates of TBI-related hospitalizations attributable to 

falls (33.9 in 2006 to 42.9 in 2014) and intentional •	 This decrease coincides with a 34% decrease in the 

self-harm (0.4 in 2006 to 0.6 in 2014). age-adjusted rate of TBI-related hospitalizations
 

attributable to motor vehicle crashes (27.6 in 2006 to
 

18.1 in 2014). 

SOURCE 

Healthcare Cost and Utilization Project’s (HCUP) Nationwide Inpatient Sample. 

¶

Age-adjusted to the 2000 U.S. standard population. ††Includes falls of undetermined intent to maintain consistency with past data 

releases. ‡‡E-codes specify that the injury was unintentional but do not specify the actual mechanism of injury. §§Includes TBIs in which 

the intent was not determined as well as those due to legal intervention or war. Includes TBIs in which no mechanism was specified in 

the record. Does not include falls of undetermined intent. 
TBI: SURVEILLANCE REPORT DATA

2006 

82,873 

103,608 

8,126 

21,905 

1,339 

21,270 

39,535 

Motor vehicle crashes 

Unintentional falls††

Unintentionally struck by or against an object 

Other unintentional injury, mechanism unspecified‡‡

Intentional self-harm 

Assault 

Other or no mechanism specified§§

2007 

71,274 

104,319 

7,684 

19,754 

1,293 

20,648 

42,378 

2008 

71,468 

120,775 

7,577 

22,025 

1,235 

22,405 

21,532 

2009 

70,039 

129,456 

7,659 

21,775 

1,351 

21,873 

25,162 

2010 

84,324 

144,854 

8,815 

25,226 

1,778 

25,355 

35,642 

2011 

58,115 

134,771 

7,218 

20,101 

1,395 

18,562 

27,318 

2012 

66,755 

141,620 

7,885 

21,705 

1,655 

19,545 

31,195 

2013 

60,465 

141,855 

7,010 

20,080 

1,665 

17,520 

32,960 

2014 

58,795 

150,745 

7,090 

21,195 

1,730 

17,395 

31,470 

 

 

 

17 

FIGURE 3B: ESTIMATED NUMBER OF TRAUMATIC BRAIN INJURY–RELATED HOSPITALIZATIONS‡, BY YEAR
 

AND MECHANISM OF INJURY, 2006-2014
 

Key Findings: 

•	 The number of TBI-related hospitalizations increased 

by 3.5% from 278,655 in 2006 to 288,420 in 2014. 

•	 From 2006 to 2014, the number of TBI-related hospitalizations attributable to motor vehicle crashes, unintentionally being struck by or against an object, and assault 

decreased by 29%, 12.7%, and 18.2%, respectively. 

•	 During this same timeframe, the number of TBI-related hospitalizations attributable to unintentional 

falls and intentional assault increased by 45.5% and 

29.2%, respectively. 

SOURCE 

Healthcare Cost and Utilization Project’s (HCUP) Nationwide Inpatient Sample. 

‡

In-hospital deaths and patients who transferred from another hospital were excluded. ††Includes falls of undetermined intent to maintain 

consistency with past data releases. ‡‡E-codes specify that the injury was unintentional but do not specify the actual mechanism of 

injury. §§Includes TBIs in which the intent was not determined as well as those due to legal intervention or war. Includes TBIs in which no 

mechanism was specified in the record. Does not include falls of undetermined intent. 
TBI: SURVEILLANCE REPORT DATA

2006 

5.4 

3.6 

0.1 

1.4 

4.7 

2.0 

0.7 

17.9 

Motor vehicle crashes 

Unintentional falls††

Unintentionally struck by or against an object 

Other unintentional injury, mechanism unspecified‡‡

Intentional self-harm 

Assault 

Other or no mechanism specified§§

Total 

2007 

5.0 

3.7 

0.1 

1.4 

4.8 

2.0 

0.7 

17.8 

2008 

4.4 

3.8 

0.1 

1.3 

5.0 

1.9 

0.7 

17.2 

2009 

3.9 

3.9 

0.1 

1.2 

5.1 

1.8 

0.7 

16.6 

2010 

3.6 

4.1 

0.1 

1.2 

5.2 

1.7 

0.7 

16.5 

2011 

3.5 

4.1 

0.1 

1.2 

5.3 

1.7 

0.7 

16.6 

2012 

3.6 

4.2 

0.1 

1.2 

5.4 

1.7 

0.8 

16.8 

2013 

3.4 

4.3 

0.1 

1.1 

5.6 

1.6 

0.7 

16.8 

2014 

3.3 

4.4 

0.1 

1.2 

5.5 

1.6 

0.7 

16.8 

18 

FIGURE 4A: AGE-ADJUSTED RATES¶

, PER 100,000 POPULATION, OF TRAUMATIC BRAIN INJURY–RELATED
 

DEATHS, BY YEAR AND MECHANISM OF INJURY, 2006-2014
 

Key Findings: 

•	 From 2006 to 2014, age-adjusted rates of TBI-relat- •	 From 2006 to 2014, age-adjusted rates of TBI-reed deaths decreased by 6% (from 17.9 per 100,000 lated deaths attributable to falls and intentional 

population to 16.8). self-harm increased (from 3.6 to 4.4 and from 4.7 to 

5.5, respectively). •	 This decrease coincides with a large decrease in the
 

age-adjusted rate of TBI-related deaths attributable
 

to motor vehicle crashes (5.4 in 2006 to 3.3 in 2014).
 

SOURCE 

CDC’s National Vital Statistics System. 

¶

Age-adjusted to the 2000 U.S. standard population. ††Includes falls of undetermined intent to maintain consistency with past data 

releases. ‡‡E-codes specify that the injury was unintentional but do not specify the actual mechanism of injury. §§Includes TBIs in which 

the intent was not determined as well as those due to legal intervention or war. Includes TBIs in which no mechanism was specified in 

the record. Does not include falls of undetermined intent. 
TBI: SURVEILLANCE REPORT DATA

2006 

16,260 

10,952 

371 

4,335 

14,292 

6,051 

2,172 

Motor vehicle crashes 

Unintentional falls††

Unintentionally struck by or against an object 

Other unintentional injury, mechanism unspecified‡‡

Intentional self-harm 

Assault 

Other or no mechanism specified§§

2007 

15,080 

11,781 

376 

4,371 

14,833 

6,058 

2,200 

2008 

13,490 

12,349 

396 

4,163 

15,585 

5,742 

2,100 

2009 

12,074 

12,835 

339 

3,774 

15,981 

5,483 

2,181 

2010 

11,235 

13,405 

369 

3,814 

16,519 

5,182 

2,313 

2011 

11,136 

13,662 

373 

3,891 

17,240 

5,227 

2,308 

2012 

11,314 

14,299 

373 

3,948 

17,609 

5,261 

2,578 

2013 

10,781 

15,083 

349 

3,772 

18,321 

5,102 

2,513 

2014 

10,656 

15,939 

378 

3,889 

18,485 

4,906 

2,547 

 

 

19 

FIGURE 4B: NUMBER OF TRAUMATIC BRAIN INJURY–RELATED DEATHS, BY YEAR AND MECHANISM 

OF INJURY, 2006-2014 

Key Findings: 

•	 The number of TBI-related deaths increased by 4.3% •	 During this same timeframe, the number of TBI-refrom 54,433 in 2006 to 56,800.	 lated deaths attributable to unintentional falls and 

intentional self-harm increased by 45.5% and 29.3%, •	 From 2006 to 2014, the number of TBI-related 

respectively. deaths attributable to motor vehicle crashes and homicide decreased by 34.4% and 18.9% respectively.
 

SOURCE 

CDC’s National Vital Statistics System. 

††Includes falls of undetermined intent to maintain consistency with past data releases. ‡‡E-codes specify that the injury was unintentional 

but do not specify the actual mechanism of injury. §§Includes TBIs in which the intent was not determined as well as those due to legal 

intervention or war. Includes TBIs in which no mechanism was specified in the record. Does not include falls of undetermined intent. 
APPENDIX 
TBI: SURVEILLANCE REPORT DATA

 

21 

Methodological Appendix 

To estimate the national incidence of TBI-related ED visits and hospitalizations, we analyzed 2014 data from the 

Healthcare Cost and Utilization Project’s Nationwide Emergency Department Sample and National Inpatient 

Sample. HCUP is a suite of state-based administrative health care record databases and serves as a resource 

of encounter-level health care.2 NEDS is the largest all-payer ED record database in the U.S. and when weighted 

it contains data on approximately 135 million ED visits.12 During 2014, NEDS contained ED discharge data from 

945 hospitals located in 33 states and the District of Columbia (D.C). This sample represents a 20% stratified 

sample of U.S. hospital based EDs.12 Similar to NEDS, NIS is the largest all-payer inpatient care record database 

in the U.S. and when weighted it contains data on approximately 35 million national hospital stays.13 During 

2014, NIS contained data from all states participating in HCUP and approximated a 20% stratified sample of 

hospitalizations from U.S. community hospitals, excluding long-term acute care and rehabilitation hospitals.13

Weighting procedures for HCUP databases are outlined here.14-15 For the 2006 to 2014 TBI trend analysis we 

used revised weights for NIS data from 2011 and earlier, due to the 2012 change in the sampling frame for this 

dataset. Information on the NIS data sampling frame change has been published elsewhere.1,16

Records from both NEDS and NIS do not include patient identifiers which creates the possibility that these 

datasets may contain more than one record per person. To reduce the possibility of counting multiple 

encounters for the same injury, specific records were excluded. Hospital transfers and admissions that 

occurred directly from the ED were excluded in ED counts as each would be captured in the hospitalization 

data. In-hospital deaths were excluded from hospitalization counts because these would be included in 

mortality data. 

Counts of the national incidence of TBI-related deaths was performed by analyzing the multiple-cause-of-death 

files from the 2014 National Vital Statistics System (NVSS). NVSS captures data for all deaths registered in 

all 50 U.S. states and D.C.3

 Record-Axis Condition codes were used (usually included both Part I and Part II of 

Entity-Axis Condition codes) for statistical analysis of TBI-related deaths. 

Estimated numbers of TBI-EDHDs are subject to rounding error due to records with missing age. However, 

this concern is reduced as less than 0.1% of ED and hospitalization records were missing age and 0% of 

mortality records were missing age during 2014. SAS version 9.3 (SAS Institute Inc., Cary, NC) was used for 

all statistical analyses. 
TBI: SURVEILLANCE REPORT DATA

 

22 

References
 

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TBI: SURVEILLANCE REPORT DATA 23 

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